Healthcare Provider Details

I. General information

NPI: 1720676620
Provider Name (Legal Business Name): ABIGAIL WASHBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7320 N PALMYRA RD
CANFIELD OH
44406-9709
US

IV. Provider business mailing address

14110 MAHONING AVE
NORTH JACKSON OH
44451-9616
US

V. Phone/Fax

Practice location:
  • Phone: 330-533-8755
  • Fax:
Mailing address:
  • Phone: 330-752-6321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCOND20201599SP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: